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Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

As someone who will soon will need to buy insurance through an ACA exchange – but doesn’t know whether that will still be possible – I’ve been thinking about my healthcare needs a lot, and how to meet them effectively if I’m ever uninsured.

Being an e-patient, the first thing that crossed my mind was to explore what Internet connectivity could do for me. And it occurred to me that if I had access to a wider range of comparatively-affordable telemedical services, I just might be able to access enough doctors and advanced practice clinicians to survive. (Of course, hospital and prescription drug costs won’t be tamed that easily, but that’s a subject for a different column.)

I admit that video visits aren’t an ideal solution for me and my husband, as we both have complex, chronic health conditions to address. But if I end up without insurance, I hold out hope that cheaper telemedicine options will get me through until we find a better solution.

Right now, unfortunately, telemedical services largely seem to be delivered on a hit-or-miss basis – with some specialties being easy to find and others almost inaccessible via digital connectivity – but if enough people like me are forced to rely on these channels perhaps this will change.

What’s available and what isn’t

This week, I did some unscientific research online to see what kind of care consumers can currently access online without too much fuss. What I found was a decidedly mixed bag. According to one telehealth research site, a long list of specialties offer e-visits, but some of them are much harder to access than others.

As you might have guessed, primary care – or more accurately, urgent care — is readily available. In fact one such provider, HealthTap, offers consumers unlimited access to its doctors for $99 a month. Such unfettered access could be a big help to patients without insurance.

And some specialties seem to be well-represented online. For example, if you want to get a dermatology consult, you can see a dermatologist online at DermatologistOnCall, which is partnered with megapharmacy Walgreens.

Telepsychiatry seems to be reasonably established, though it doesn’t seem to be backed yet by a major consumer branding effort. On the other hand, video visits with talk therapists seem to be fairly commonplace these days, including an option provided by HealthTap.

I had no trouble finding opportunities to connect with neurologists via the Web, either via email or live video. This included both multispecialty sites and at least one (Virtual Neurology) dedicated to offering teleneurology consults.

On the other hand, at least in searching Google, I didn’t find any well-developed options for tele-endocrinology consults (a bummer considering that hubby’s a Type 2 diabetic). It was the same for tele-pulmonology services.

In both of the former cases, I imagine that such consults wouldn’t work over time unless you had connected testing devices that, for example allow you to do a peak flow test, spirometry, blood or urine test at home. But while such devices are emerging, I’m not aware of any that are fully mature.

Time to standardize

All told, I’m not surprised that it’s hit or miss out there if you want to consult your specialists via an e-visit. There are already trends in place, which have evolved over the last few years, which favor some specialties and fail to address others.

Nonetheless, particularly given my perilous situation, I’m hoping that providers and trade groups will develop some standardized approaches to telemedicine. My feeling is that if a specialty-specific organization makes well-developed clinical, technical, operational and legal guidelines available, we’ll see a secondary explosion of new tele-specialties emerge.

In fact, even if I retain my health insurance benefits, I still hope that telemedical services become more prevalent. They’re generally more cost-efficient than traditional care and certainly more convenient. And I’m pretty confident that I’m not the only one champing at the bit here. Let’s roll ‘em out, people!

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